Effect of Remote Ischemic Conditioning vs Usual Care on Neurologic Function in Patients With Acute Moderate Ischemic Stroke
Authors: Hui-Sheng Chen, Yu Cui, Xiao-Qiu Li, Xin-Hong Wang, Yu-Tong Ma, Yong Zhao, Jing Han, Chang-Qing Deng, Mei Hong, Ying Bao, Li-Hong Zhao, Ting-Guang Yan, Ren-Lin Zou, Hui Wang, Zhuo Li, Li-Shu Wan, Li Zhang, Lian-Qiang Wang, Li-Yan Guo, Ming-Nan Li, Dong-Qing Wang, Qiang Zhang, Da-Wei Chang, Hong-Li Zhang, Jing Sun, Chong Meng, Zai-Hui Zhang, Li-Ying Shen, Li Ma, Gui-Chun Wang, Run-Hui Li, Ling Zhang, Cheng Bi, Li-Yun Wang, Duo-Lao Wang, Shi-Mei Geng, Jing Shi, Ming Sun, Xiao-Feng Qiu, Hai-Tao Jiang, Yu-Jie Zhang, Jing-Yang Chen, Rui-Ping Wang, Fu-Sheng Bai, Jing Li, Xiao-Hui Gong, Ying Bai, Yan-Song Li, Ye-Fang Feng, Chong Ha, Chang-Hao Jiang, Jin-Hua Zhai, Bing Han, Ye Wang, Dong-Yu Wang, Kui-Hua Yang, Hai-Yan Yu, Xiu-Kun Yu, Hong-Bo Xiao, Chun Nie, Zhen Jiao, Jing-Yu Li, Zhao-Min Meng, Shao-Yuan Chen, Xiao-Hong Song, Jun Xu, Li Li, Xiao-Ling Wang, Xiao-Jie Wang, Wen-Xiang Zheng, Wen-Xu Zheng, Ya-Jun Liu, Min Yu, Juan Feng
Journal: JAMA (2022)

<h3>Importance</h3> Preclinical and clinical studies have suggested a neuroprotective effect of remote ischemic conditioning (RIC), which involves repeated occlusion/release cycles on bilateral upper limb arteries; however, robust evidence in patients with ischemic stroke is lacking. <h3>Objective</h3> To assess the efficacy of RIC for acute moderate ischemic stroke. <h3>Design, Setting, and Participants</h3> This multicenter, open-label, blinded–end point, randomized clinical trial including 1893 patients with acute moderate ischemic stroke was conducted at 55 hospitals in China from December 26, 2018, through January 19, 2021, and the date of final follow-up was April 19, 2021. <h3>Interventions</h3> Eligible patients were randomly assigned within 48 hours after symptom onset to receive treatment with RIC (using a pneumatic electronic device and consisting of 5 cycles of cuff inflation for 5 minutes and deflation for 5 minutes to the bilateral upper limbs to 200 mm Hg) for 10 to 14 days as an adjunct to guideline-based treatment (n = 922) or guideline-based treatment alone (n = 971). <h3>Main Outcomes and Measures</h3> The primary end point was excellent functional outcome at 90 days, defined as a modified Rankin Scale score of 0 to 1. All end points had blinded assessment and were analyzed on a full analysis set. <h3>Results</h3> Among 1893 eligible patients with acute moderate ischemic stroke who were randomized (mean [SD] age, 65 [10.3] years; 606 women [34.1%]), 1776 (93.8%) completed the trial. The number with excellent functional outcome at 90 days was 582 (67.4%) in the RIC group and 566 (62.0%) in the control group (risk difference, 5.4% [95% CI, 1.0%-9.9%]; odds ratio, 1.27 [95% CI, 1.05-1.54];<i>P</i> = .02). The proportion of patients with any adverse events was 6.8% (59/863) in the RIC group and 5.6% (51/913) in the control group. <h3>Conclusions and Relevance</h3> Among adults with acute moderate ischemic stroke, treatment with remote ischemic conditioning compared with usual care significantly increased the likelihood of excellent neurologic function at 90 days. However, these findings require replication in another trial before concluding efficacy for this intervention. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT03740971